A familiar sight to HSFY students of recent years – popular teacher Tony Zaharic of the biochemistry department. Image courtesy of University of Otago Marketing and Communications.

Health Sciences First Year (HSFY) is a term very familiar to anybody who has been around the university over the past couple of decades. Students aiming to enter one of Otago’s undergraduate health science degrees – dentistry, medical laboratory science, medicine, pharmacy and physiotherapy – complete this shared course in their first year of university study. Entry to the professional degrees is also available to some graduates, but most come via the HSFY course, which brings a large number of students to Otago. The course has undergone a few changes since it first appeared under this guise in 1998 and it was built on a much older tradition of the ‘intermediate’ year; I thought it would be interesting to look back over the long history of first year health science courses.

When the medical school started out in the 1870s it could only offer the first two years of a medical course and students headed overseas – most often to Edinburgh – to complete their training. Prospective doctors had to register as medical students, which required them to pass a ‘preliminary examination in general education’. Once registered, medical students started out on their two-year course in chemistry, biology, anatomy, physiology, surgery and clinical instruction at the hospital. From 1885 students could complete their entire medical course at Otago. To obtain a New Zealand medical degree, they needed to pass an intermediate exam, followed by three professional exams. The intermediate exam covered a general university science prospectus of biology, physics and chemistry.

The dental school opened in 1907, offering a four-year degree, later extended to five years. Students had to formally register for the course and this required passing the same preliminary exam as medical students. Also like medical students, they took the standard first-year courses in physics and chemistry, but added to the biology requirement was a course in dental anatomy. There was little rest for dental and medical students, for as soon as their first-year exams were over they commenced their specialist courses with a ‘summer term’. For many years there was, however, no competition for places: anybody who could pay the fees, complete the courses and pass the exams could qualify as a doctor or dentist.

In 1941, faced with rising student numbers and significant overcrowding, the Otago medical school for the first time limited entry to its second-year classes, initially to 100 students. Some places were reserved for graduates and people repeating second year, but for most students entry came through obtaining the best exam marks in the intermediate course. No intermediate medical student could afford to rest on their laurels now: competition for entry to medical school varied from year to year but was generally tough. Some of those who did not gain entry to the medical course instead enrolled for dentistry. From 1945 the specialist dental course disappeared from first year and prospective dentists took exactly the same intermediate course as prospective doctors, that is, first-year chemistry, physics and biology (zoology and botany). Unsurprisingly, the dental course then became crowded, exacerbated by an influx of returned servicemen to university. From 1947 entry to second-year classes in the dental school was also limited, initially to 50 places.

Dental students working in the prosthetics lab in 1949. Before reaching this stage they had to overcome the hurdle of a competitive intermediate year. From left: Brian Arkinstall, Jim Armour, Reece Baker, Clive Bayley, Rod Beattie and Nick Bebich. Image courtesy of Elaine Donaldson.

The medical school began offering a Bachelor of Pharmacy degree in the 1960s, though most New Zealand pharmacists trained through a technical institute diploma course until 1991, when Otago’s newly independent school of pharmacy became the country’s sole training programme for pharmacists. The intermediate year for pharmacy was the same as that for medicine or dentistry – chemistry, biology and physics.

The intermediate health science courses remained essentially unchanged for many years, though there were of course some changes to the content of the basic science courses, reflecting new scientific developments. Over time, though, questions arose about the suitability of the criteria for entry to health science courses: did New Zealanders want their doctors and dentists selected purely through their ability to obtain top marks in science exams? Academic ability and scientific understanding were clearly important, but the best health professionals also needed some sympathetic understanding of the human condition and good communication skills. Extensive changes to the medical curriculum in the 1970s included modifications to the long-standing biology/chemistry/physics requirement of the intermediate course. From 1973 students took four subjects in their intermediate year: chemistry, biology and any two subjects of their choice from the arts or sciences (those who hadn’t got 50% or more in either maths or physics at bursary level had to include one of those among the two options). While some students stuck with the sciences, others branched out, with anthropology a popular choice. From 1981 students without an arts background were forced to think more laterally, as those without 50% or more in an arts subject at bursary level had to include an arts paper in their medical intermediate programme. The dentistry intermediate also added a fourth subject, taken in any of the arts and sciences, in 1980. Pharmacy retained a more scientific focus for longer. It added a statistics paper to its biology, chemistry and physics intermediate year from 1975. It was not until 1988 that pharmacy intermediates had a wider choice: they could then choose between physics and statistics, freeing them up to take their fourth course from any within the science, arts or commerce offerings.

Concerns remained about the communication skills of the medical profession. In 1993 the English department introduced a new paper primarily designed for health science students (though also open to others): ‘language, style and communication’, an ‘introduction to the fundamentals of effective speaking and writing’. This became a compulsory part of the intermediate years for medicine and pharmacy, unless a student had a good pass in bursary English; dental students were also advised to take an approved English paper from 1995.

1998 brought the biggest change yet to intermediate courses, with a completely revamped programme named Health Sciences First Year. Controversially, the course had to be taken in Dunedin; previously students had been able to complete their intermediate year at any university. Cynics noted that this increased Otago’s student numbers and thereby its funding. This was undoubtedly true, but there were also sound academic reasons behind the change. First, it was difficult to make fair comparisons between applicants who had obtained their grades in intermediate subjects at a variety of institutions. Second, and more important, Otago could now tailor its Stage 1 courses more closely to the needs of the health sciences and transfer some of the overcrowded specialist curriculum into first year. The course included two brand new compulsory papers – foundations of biochemistry, and chemistry: molecular reactivity – together with the biology of cells and biology for health sciences. Students without exemptions also needed to complete introductory physics, introductory biostatistics and the English language, style and communication paper. Students needed a total of 8 papers, leaving them to choose between 1 and 4 other subjects. This course became the common intermediate year for medicine, dentistry, pharmacy, medical laboratory science and physiotherapy degrees. The change was most radical for physiotherapy, which previously had a tightly-structured first year programme with papers specifically designed for the profession (the Bachelor of Physiotherapy degree was jointly taught by the university and Otago Polytechnic from 1991, with the university taking sole responsibility from 1996).

HSFY was modified over the years to cater for changing health priorities and learning needs. Biostatistics morphed into epidemiology, a specialist biological physics paper was added, the compulsory English paper was dropped (except for those who failed a diagnostic test) and in 2007 a new acronym – HUBS – entered the Otago lexicon. ‘Human body systems’ replaced the former biology papers; it was a significant modification aimed at improving students’ self-directed learning skills. Throughout, the HSFY course attracted many enrolments and competition for entry to second-year classes in the professional degrees remained intense. Debate continued – and will probably never end – over selection methods. Grades remain the number one criterion, but some courses now also require prospective students to pass a psychometric test, the Undergraduate Medicine and Health Sciences Admission Test (UMAT), a widely-used tool devised in Australia. At Otago UMAT became part of the admission process for medicine in 2003, for dentistry in 2005 and for medical laboratory science in 2007; the dental school also interviewed prospective students from 2005. For some decades a number of places have been reserved for the best Maori and Pasifika applicants, because New Zealand needs more Pacific Island and Maori health professionals, while more recently the medical and dental programmes have also targeted students from rural backgrounds with a commitment to rural practice, to help overcome serious shortages of rural health practitioners.

Are you a survivor of HSFY or one of the older intermediate courses? Do you have any memories to share?